What do zombies, body snatchers, and the tobacco industry have in common?

I recently spoke to my daughter’s 7th grade science class on the dangers of smoking cigarettes and electronic cigarettes. Of course, I had to come up with a metaphor that would capture their attention — and tell a story — ZOMBIES!

World Health Organization — Health Professionals Against Tobacco

We can all imagine zombies trying to get into our home — which we have fortified to protect us from the walking dead. The zombies are the tobacco industry. The fortified home is legislation to protect us from getting bitten and becoming one of them — nicotine addicted walking dead.

However, now the zombies have become body snatchers. They look normal — like us, but their nicotine bite is just as addictive. The body snatchers are the tobacco industry peddling e-cigarettes. They lull us into believing they are the “safe alternative” (the harm reduction argument) or that smokers will quit smoking (the smoking cessation argument).

Therefore, they argue, we should allow ANYONE to smoke e-cigarettes ANYWHERE. Their arguments are a smoke screen (they would say vapor)! They could care less about smokers’ health, or anyone else’s health.

Here is what they really want:

Change social norms so that e-cigarettes are acceptable (like smoking in the 1950s)

Free e-cigarette advertising by having ubiquitous use of their product

Recruit youth into lifelong nicotine addiction

Keep and get many more addicted to their product

Make tons more money since e-cigarettes is likely less deadly than cigarettes

Here is what nicotine addiction is like (from Dr. Neal Benowitz, UCSF):

“With repeated exposure to nicotine, tolerance develops. Nicotine withdrawal causes anxiety and stress, both of which are powerful incentives to take up smoking again. … Cessation of smoking causes the emergence of withdrawal symptoms: irritability, depressed mood, restlessness, and anxiety. The intensity of these mood disturbances is similar to that found in psychiatric outpatients. Anhedonia — the feeling that there is little pleasure in life — can also occur with withdrawal from nicotine — like other drugs of abuse. … Smoking is a highly efficient form of drug administration. Inhaled nicotine enters the circulation rapidly through the lungs and moves into the brain within seconds. Rapid rates of absorption and entry into the brain cause a strongly felt “rush” and reinforce the effects of the drug. … There is considerable peak-to-trough oscillation in blood levels of nicotine from cigarette to cigarette. Nevertheless, it accumulates in the body over the course of 6 to 9 hours of regular smoking and results in 24 hours of exposure.” (N Engl J Med. 2010 Jun 17;362(24):2295-303. doi: 10.1056/NEJMra0809890.)

Why would anyone want anyone to become addicted to nicotine? Only if you can make ‘lots of money from it, I suppose. You would also have to be heartless — a zombie!

In the 1930s to 1950s smoking and tobacco products proliferated without regulations or science about the long-term effects of smoking cigarettes. What resulted was 42% of adults as active smokers in 1965, and an entire generation ravaged by the effects of cigarettes for the last several decades.

Our communities took action beginning in the 1990s and turned that trend around (12.5% of San Francisco adults smoke). Now we are faced with a new challenge that might similarly increase nicotine addiction and health harm to the community. We have a chance to act now to limit exposure to these products. Remember— the real issue is the promotion of nicotine addiction — plain and simple! Are we going to let the Zombie Industry promote nicotine addiction in our communities and to our children? We can prevent a new public health disaster?

Protect social norms that make smoking and nicotine addiction unacceptable

Protect our communities, families, and children from free e-cigarette advertising

Protect us from nicotine addiction promotion

Protect us from these zombies

The San Francisco Board of Supervisors did not buy the bogus arguments from the Zombie Industry. On March 18, 2014, they joined a growing list of cities across the country enacting legislation to extend protection from zombies to include protection from body snatchers. See “S.F. supes vote for same smoking laws for e-cigarettes” (San Francisco Chronicle, March 18, 2014)

Kudos to the San Francisco Board of Supervisors!

From the San Francisco Board of Supervisors: Health Code – Restrictions on Sale and Use of Electronic Cigarettes; Sponsors: Mar; Avalos, Chiu, Yee and Cohen: Ordinance amending the Health Code to

prohibit the use of electronic cigarettes where smoking is otherwise prohibited;

require a tobacco permit for the sale of electronic cigarettes; and

prohibit the sale of electronic cigarettes where the sale of tobacco products is otherwise prohibited.

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Many thanks to the University of California scientists and providers, health organizations (e.g., San Francisco Medical Society), and youth organizations that provided testimony supporting the regulation of e-cigarettes!

I am an ecig user and a fan of vaping, simply because it allowed my to quit smoking tobacco. Which I was unable to do for many years, but I am still addicted to nicotine and I am continuing to battle with it by reducing the e-liquid strength I use. It is because nicotine is so additive that I am in favour of strict nicotine regulation, especially when it comes to minors.

The main problem with confining the people using vapes with the people smoking cigarettes is that most of them have quit smoking. Its like trying to tell alcoholics they can only have their AA meetings in bars. If you want to regulate where people vape then have a vape section and a smoking section. But don’t make these people that have put down the cigarettes feel like their quitting means nothing.

Just because they are not using the methods of quitting that you like or that big pharma wants us to use does not negate the fact that they are quitting tobacco cigarettes.

Bravo to Dr. Aragon. Regulating – not banning – e-cigs makes perfect sense. Those who are actually using them to reduce tobacco smoking can still do so. The European Union has just not only done what SF is doing, but also banned all e-cig advertising. We are a bit more moderate in comparison, so far.

As noted, the two primary reasons for regulation – harmful substances in vapor, and marketing to youth – are becoming more apparent all the time. For those of us who believe in science and have been around awhile, this is all a true deja vu experience, as the same sort of (erroneous, ideological, and profit-motivated) arguments were made against restricting tobacco smoking in restaurants, marketing to kids, etc.

Back then, health officials and experts were correct, and the industry in question – and its apologists and front groups – were wrong. The same scenario is rolling out with respect to e-cigs.

Furthermore, e-cigarettes are not strictly marketed to smokers unable to quit smoking. The tobacco industry is interested in marketing their product to the broadest consumer base possible, specifically,teens and young adults who do not currently use a tobacco product. According to the CDC, “The three most heavily advertised brands—Marlboro, Newport, and Camel—were the preferred brands of cigarettes smoked by adolescents (ages 12–17 years) and young adults (ages 18–25 years) during 2008–2010.” (U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012 [accessed 2013 June 20].) (http://www.tobaccofreekids.org/press_releases/post/2013_09_05_ecigarettes)

The ultimate goal of tobacco companies is proliferation of their product, not reduction of tobacco usage.

Vapers are not smokers, they are ex-smokers. Forcing them to vape only where smoking is allowed, is forcing them back to smoking. You deleted my comment earlier posted about eCig nicotine hitting at a third of the power and time as real smoke nicotine. How can anyone who is cutting their smoke cravings via an eCig be able to cut their cravings when only allowed to use them during strict nanny o’clock times and places. Stop patronizing, you’re very condescending.

Thanks for your views. I apologize if I came across patronizing. My concern is directed at the tobacco industry that peddles addictive products with no health benefits. (P.S. I did not remove any previous comments.)

Cigarettes take approx 3 minutes to deliver an hours worth of satisfying nicotine. The eCig, OTH, take approx one hour to deliver only a third of the amount of nicotine that a real cigarette delivers.

At this rate, it will take years longer to recruit enough addicts to get the tax money rolling in.

Which is why the anti-zealots want the eCigs banned or joined into the MSA/TSET blood money funds right this minute, even though they are NOT tobacco products, they do NOT pollute the air, and they do NOT cause health problems to bystanders.

The anti-eCig zealots are wanting to obliterate the hurdle that stands between them and their blood money. Everyone knows the anti-eCig groups (ALA, ACS, TFK, ie) thrive off every real cigarette sold (MSA/TSET) as well as off the big Pharma grants (Pfizer ie) for helping to promote and maintain the smoking cessation products they sell.

They had a wonderful scheme going for years, until the eCig came along. Today, real smokes sales are at record low, while eCig sales are climbing. Take away the eCigs, and the MSA/grants sluts are saved.

For someone working in public health it is extremely irresponsible that you have done absolutely no research on the electronic cigarette. Getting your dose of dribble from bias media and Big Pharma reps does not constitute an going education in the field you have chosen, the teachers who let this ill informed and Pharma drugs bias propagandist loose on innocent and impressionable children should be sacked and barred from teaching immediately.

And so, the parents of the children will suffer horrible deaths as a result of the vitriol and lies produced by people whose hatred of tobacco blind them to the life saving benefits of the e cigarette.

They said…
‘Not enough research,’ they said
‘They are a gateway’
And these and other grey excuses
Are written as the epitaph
By those
Who did not pity
The dying and the dead
She did not cry
The tears had dried up so long before
His last creaking breath
Had crept from his disease ridden lungs
She had though, held his hand as life slowly left
And after,
Long after, when sorting out his things
She had come across
An antique of sorts
And she remembered the few short years of joy
When he seemed to grow young again
When the fear had lifted
But the joy had been short lived.
‘Not enough research,’ they said
‘They are a gateway’
And these and other grey excuses
Are written as the epitaph
By those
Who did not pity
The dying and the dead

You will be thrilled to know that the San Francisco health code ordinance preserves the “life saving benefits of the e cigarette” because smokers will be able to continue smoking e-cigarettes wherever they smoke regular cigarettes.

It might be a little more accurate if there were some evidence that nicotine creates dependence outside of tobacco – but there is none. Can you cite a published clinical trial where pure nicotine was administered to never-smokers and resulted in nicotine dependence? It will be very clever of you if you can, as there is no such published trial. On the other hand there are several such trials where no reinforcement was shown. All the evidence at this point is that nicotine does not create dependence without tobacco smoke.

Ecigs have zero evidence for either creating nicotine dependence or as a gateway to smoking. In any case you would first have to show evidence that nicotine can create dependence outside of tobacco smoke, and there is no such thing. Stick to fiction. Ah,yes – you did.

Because it would be unethical to conduct a randomized controlled trial with electronic cigarettes, we will never have RCT evidence that e-cigarettes are addictive. This was also true for regular cigarettes, and in fact, the tobacco industry argued that smoking did not cause cancer because there was no RCT evidence to prove causation. Sound familiar?

It doesn’t matter how many experts say: “nicotine is addictive because smoking is addictive”. Saying something a thousand times with no evidence for it is called propaganda. Benowitz work references smoking, not pure nicotine consumed by never-smokers. Applying the effects of something with 9,600 integral compunds identified so far to one of its components is plainly ridiculous, especially when all it requires is a very simple, quick, cheap, and easy trial to establish or refute.

It is certainly not unethical to carry out clinical trials where large amounts of pure nicotine are administered to never-smokers for months at a time. There are several clinical trials that did exactly that, and the results are always the same: nicotine does not create dependence. Nicotine without tobacco does not create dependence, multiple clinical trials report this, and ethics panels have no problem authorising such trials.

They have no problem with such trials because even the major national authorities such as NICE and the FDA no longer consider nicotine to be either ‘addictive’ or harmful. NICE tell you this in PH45 and it is the official instruction to all UK medical practitioners. The FDA are removing all cautionary labels that warn about addiction or harm on nicotine-containing medicines.

There is not a single published clinical trial that reports pure nicotine administered to never-smokers can create dependence; there should be dozens if not hundreds if your position were to be correct. A single such trial would have a value to your industry of the order of tens (if not hundreds) of millions of dollars, so its absence is clearly indicative of the problem: trials with inconvenient results are not published.

Once again: find me a reference to a single clinical trial that supports your position.

Or, explain to me why there are none, when we know that ethics committees have no problem with such trials.

“Nicotine may have some adverse health effects, but they are relatively minor,” said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine. (See this article.)

Dr. Neal Benowitz is correct, compared to regular cigarettes, e-cigarettes has much less exposure to carcinogens in tobacco smoke. However, nicotine is addictive — PERIOD. Therefore, you will agree with me that the “the real issue is the promotion of nicotine addiction …” In San Francisco, smokers will continue to have the freedom to smoke e-cigarettes anywhere they smoke regular cigarettes. Here is Dr.Benowitz’s full citation: Benowitz NL. Emerging nicotine delivery products. Implications for public
health. Ann Am Thorac Soc. 2014 Feb;11(2):231-5. doi:
10.1513/AnnalsATS.201312-433PS. PMID: 24575992.

No Tomás Aragón, the real issue is the not promotion of nicotine addiction. It’s the delivery method of that nicotine. Don’t start moving goal posts now. The end game for smoking is in sight and by moving the target to nicotine addiction (what dose that even mean?) we are in real danger of missing the real goal of eliminating smoking prevalence.

You need to embrace e-cigarettes and shepherd their development so that the best possible outcome can be achieved.

Bans and restrictions based on some moral repugnance to what you perceive to be a problem will only hamper your efforts to get to a smokfree world, never mind a tobacco free world (hint e-cigs do not contain tobacco and are not the trojan horse of the tobacco industry).

Please don’t confuse young minds with your half truths as they will only ignore you in the future when they realize that you are the boy crying wolf.

Tom Gleeson wrote: “You need to embrace e-cigarettes and shepherd their development so that the best possible outcome can be achieved.”

You will be very happy to know that the San Francisco health ordinance does NOT ban the sale or use of e-cigarettes. Smokers will be able to smoke all the e-cigarettes they want wherever they currently smoke regular cigarettes.

The San Francisco health ordinance is balanced and does NOT add additional burdens or restrictions on current cigarette smokers.